FIGURE 8.28 Medial aspect of the right knee/leg. (Adapted from Tank PW, Gest TR Lippincott Williams & Wilkins Atlas of Anatomy. Philadelphia, PA: Lippincott Williams & Wilkins, 2009.)
PATIENT POSITION
- Lying supine on the examination table with the affected knee extended or slightly flexed and supported with folded towels or chucks pads as needed for patient comfort.
- Rotate the patient’s head away from the side that is being injected. This minimizes anxiety and pain perception.
LANDMARKS
1. With the patient lying supine on the examination table, the clinician stands lateral to the affected knee.
2. The point of maximal tenderness over the proximal medial anterior tibia is identified.
3. At that site, press firmly on the skin with the retracted tip of a ballpoint pen. This indention represents the entry point for the needle.
4. After the landmarks are identified, the patient should not move the knee.
ANESTHESIA
- Local anesthesia of the skin using topical vapocoolant spray
EQUIPMENT
- 3-mL syringe
- 25-gauge, 1 in. needle
- 1 mL of 1% lidocaine without epinephrine
- 0.5 to 1 mL of the steroid solution (20 to 40 mg of triamcinolone acetonide)
- One alcohol prep pad
- Two povidone–iodine prep pads
- Sterile gauze pads
- Sterile adhesive bandage
- Nonsterile, clean chucks pad
TECHNIQUE
1. Prep the insertion site with alcohol followed by the povidone–iodine pads.
2. Achieve good local anesthesia by using topical vapocoolant spray.
3. Position the needle and syringe perpendicular to the skin with the tip of the needle directed toward the area of maximal tenderness at the insertion of the tendons.
4. Using the no-touch technique, introduce the needle at the insertion site (Fig. 8.29).
5. Advance the needle toward the bone of the proximal medial tibia. Back up the needle 1 to 2 mm.
6. Inject the steroid solution as a bolus into this area. The injected solution should flow smoothly into the space. If increased resistance is encountered, advance or withdraw the needle slightly before attempting further injection.
7. Following injection of the corticosteroid solution, withdraw the needle.
8. Apply a sterile adhesive bandage.
9. Instruct the patient to massage this area and move his or her knee through its full range of motion. This movement distributes the steroid solution throughout the pes anserine bursa and related tendons.
10. Reexamine the pes anserine bursa in 5 min to confirm pain relief.
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